Comparison of Superior Hypogastric Plexus Block and Peritoneal Bupivacaine in Pain Management

Comparison of Superior Hypogastric Plexus Block and Peritoneal Bupivacaine in Pain Management After Laparoscopic Hysterectomy

Background: Laparoscopic hysterectomy is one of the most frequently performed major surgeries in nonmalignant gynecological diseases. Effective postoperative analgesia is associated with short hospital stays, early mobilization, reduced costs, and patient satisfaction. Intravenous administration of nonsteroidal anti-inflammatory drugs, paracetamol or opioids; epidural catheter placement; peritoneal local anaesthetic administration; and superior hypogastric plexus block (SHPB) are routinely employed methods for postoperative pain management following laparoscopic hysterectomy.

Methods: The study population comprised patients who underwent laparoscopic hysterectomy with or without oophorectomy for benign indications. A total of 94 patients were included in the study. Thirty patients received a superior hypogastric plexus block, thirty received intraperitoneal local anaesthetic spray, and thirty-four received intravenous analgesics.

Conclusion: In the present study, a comparison of postoperative pain management in patients who underwent laparoscopic hysterectomy was conducted.

Study Overview

• Status: Completed
• Conditions: Superior Hypogastric Plexus Block; Intraperitoneal Bupivacaine
• Intervention / Treatment: Drug: Intraperitoneal Bupivacaine spray; Drug: Dexketoprofen (KETAVEL 50 mg/2 ml); Drug: Bupivacain

Detailed Description

In the present study, a comparison of postoperative pain management in patients who underwent laparoscopic hysterectomy was conducted. The findings indicated that the initial postoperative administration of analgesics occurred later in patients who received peritoneal local anesthetics and SHPB compared to the control group. In addition, VAS values at the first and third hours were found to be lower in the peritoneal local anesthetic and SHPB groups than in the control group. Postoperative pain experienced by patients following gynecologic surgery. It has been reported that approximately 75% of patients experience severe pain. Excessive opioid use in postoperative pain management and the potential for additional complications are also possible. One of the alternative methods to reduce postoperative opioid use is intraperitoneal bupivacaine administration.

• Study Type: Observational
• Enrollment (Actual): 94

Contacts and Locations

Study Locations

• Turkey
  • Mardin, Turkey
    • Mardin Artuklu University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population comprised patients who underwent laparoscopic hysterectomy-with or without oophorectomy-for benign indications (such as myoma uteri, dysfunctional uterine bleeding, uterine prolapse, or precancerous cervical lesions) between July 2024 and December 2024, and who were classified as ASA physical status I-II. Patients were excluded if they were younger than 18 or older than 65, underwent epidural catheterisation and/or received additional pain management modalities (e.g., transversus abdominis plane block, local wound infiltration, quadratus lumborum block), had surgery for malignancy, underwent a different surgical approach (e.g., transvaginal natural orifice transluminal endoscopic surgery), or were prescribed preoperative antidepressants or gabapentinoids.

Description

Inclusion Criteria:

• patients who underwent laparoscopic hysterectomy-with or without oophorectomy-
• ASA physical status I-II patients

Exclusion Criteria:

• women with known bupivacaine allergy, anxiety-depressive disorders, fibromyalgia, coagulopathy, eclampsia/preeclampsia, or those who were pregnant were also excluded.
• if they were younger than 18 or older than 65
• underwent epidural catheterisation and/or received additional pain management modalities
• prescribed preoperative antidepressants or gabapentinoids

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
intraperitoneal local anaesthetic spray (Group B)	Drug: Intraperitoneal Bupivacaine spray; The peritoneal cavity and abdominal wall were treated with 30 milliliters of 0.25% bupivacaine, with a focus on areas involving the peritoneum in the lower abdominal region.
intravenous analgesics (Group C)	Drug: Dexketoprofen (KETAVEL 50 mg/2 ml); In cases where the VAS score exceeded 3 in the postoperative period, it was deemed that the patient's analgesia was insufficient, prompting the intravenous administration of 50 mg of dexketoprofen sodium.
superior hypogastric plexus block (Group S)	Drug: Bupivacain; The superior hypogastric plexus block (SHPB) was performed following uterine removal and closure of the vaginal cuff, but prior to trocar removal from the abdominal cavity. The promontory was identified under laparoscopic visualization. The posterior peritoneum overlying the promontory was gently grasped and elevated with an instrument to create a peritoneal tent. A needle was then inserted at the apex of the tent and advanced approximately 1 cm. At this point, a subperitoneal space was further expanded using a surgical instrument, and 30 ml of 0.25% bupivacaine was injected into the area

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VAS (vısual analog scale)	For patients with no pain, VAS was recorded as 0 (zero), and for those with unbearable pain, VAS was recorded as 10 (ten).	24 HOUR

Collaborators and Investigators

• Sponsor: Enes Celik

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2024
• Primary Completion (Actual): December 30, 2024
• Study Completion (Actual): February 20, 2025

Study Registration Dates

• First Submitted: April 14, 2025
• First Submitted That Met QC Criteria: April 30, 2025
• First Posted (Actual): May 2, 2025

Study Record Updates

• Last Update Posted (Actual): May 2, 2025
• Last Update Submitted That Met QC Criteria: April 30, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Hysterectomy; Intraperitoneal Injections; Hypogastric Plexus
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Anti-Inflammatory Agents; Peripheral Nervous System Agents; Antirheumatic Agents; Anesthetics, Local; Anesthetics; Central Nervous System Depressants; Sensory System Agents; Analgesics, Non-Narcotic; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Dexketoprofen trometamol
• Other Study ID Numbers: ArtukluU-MED-EC-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No